Kidney Failure

Proton pump inhibitors might cause serious kidney damage

04/2016REBECCA ZUMOFFNew research published in the Journal of the American Society of Nephrology (JASN) indicates that long-term use of proton pump inhibitors (PPIs), commonly used to treat heartburn, acid reflux, and ulcers can have damaging effects on the kidneys.

In 2013, an estimated 15 million Americans were prescribed PPIs, which reduce gastric acid production. This number is likely an underestimate because the medications are also available over-the-counter and can be purchased without prescription, according to background information for the study.

A study published in JAMA Internal Medicine in January also showed a connection between the drugs and kidney damage.

To assess the safety of this widely used drug class, a team led by Yan Xie, MPH and Ziyad Al-Aly, MD, FASN, from the Clinical Epidemiology Center at the VA Saint Louis Health Care System and Washington University in St. Louis, analyzed information from the Department of Veterans Affairs national databases. The investigators identified 173,321 new users of PPIs and 20,270 new users of histamine H2 receptor blockers, an alternative class of drugs also used to suppress stomach acid. Over five years of follow-up, those taking PPIs were more likely to experience kidney function decline than those taking H2 receptor blockers. PPI users also had a 28% increased risk of developing chronic kidney disease and a 96% increased risk of developing kidney failure. Furthermore, there was a graded association between duration of PPI use and risk of kidney problems, with those who took PPIs for a longer time being more likely to develop kidney issues.

The findings suggest that long-term use of PPIs may be harmful to the kidneys and should be avoided. PPI use may not only increase the risk of developing chronic kidney disease, but may also increase the risk of its progression to complete kidney failure.

“The results emphasize the importance of limiting PPI use only when it is medically necessary, and also limiting the duration of use to the shortest duration possible,” said Dr. Al-Aly.” A lot of patients start taking PPIs for a medical condition, and they continue much longer than necessary.”

The results also provide insights for future investigations on drug safety. “The study serves as a model to leverage the availability of Big Data—with VA data being a prime example—and advanced analytics to determine long term safety profiles of commonly used medications and promote pharmacovigilance,” said Xie.

01/2016The JAMA Network JournalsProton pump inhibitors (PPIs), which are commonly used drugs to reduce acid in the stomach, appear to be associated with an increased risk of chronic kidney disease but more research is needed to determine whether PPI use causes kidney damage, according to an article published online byJAMA Internal Medicine.PPIs are one of the most commonly prescribe medications in the United States and an estimated 25 percent to 70 percent of these prescriptions may have no appropriate indication for use. Other observational studies have linked PPIs to serious adverse health outcomes. However, the authors note that no population-based studies, to their knowledge, have looked at the association between PPI use and the risk of chronic kidney disease (CKD).Morgan E. Grams, M.D., Ph.D., of Johns Hopkins University, Baltimore, and coauthors quantified the association between PPI use and incident CKD in the general population using data on self-reported PPI use in the Atherosclerosis Risk in Communities (ARIC) study (10,482 participants followed up for a median of nearly 14 years) or an outpatient PPI prescription in the Geisinger Health System in Pennsylvania (248,751 participants followed up for a median of six years). The results were replicated at Geisinger.At baseline, PPI users in both groups were more likely to have a higher body mass index and take antihypertensive, aspirin or statin medications.In the ARIC group, there were 56 incident CKD events among 322 baseline PPI users (14.2 per 1,000-person years) and 1,382 events among 10,160 baseline nonusers (10.7 per 1,000 person-years). PPI use was associated with risk of incident CKD in unadjusted and adjusted analyses. The 10-year estimated absolute risk of CKD among the 322 baseline PPI users was 11.8 percent while the expected risk had they not used PPIs was 8.5 percent, according to the results.In the replication group at Geisinger, there were 1,921 incident CKD events among 16,900 baseline PPI users (20.1 per 1,000 person-years) and 28,226 events among 231,851 baseline nonusers (18.3 per 1,000 person-years). PPI use was associated with risk of incident CKD in analyses. The 10-year absolute risk of CKD among the 16,900 baseline PPI users was 15.6 percent and the expected risk had they not used PPIs was 13.9 percent, results indicate.The authors note several study limitations, including that participants who are prescribed PPIs may be at higher risk of CKD for reasons unrelated to their PPI use."We note that our study is observational and does not provide evidence of causality. However, a causal relationship between PPI use and CKD could have a considerable public health effect given the widespread extent of use. More than 15 million Americans used prescription PPIs in 2013, costing more than $10 billion. Study findings suggest that up to 70 percent of these prescriptions are without indication and that 25 percent of long-term PPI users could discontinue therapy without developing symptoms. Indeed, there are already calls for the reduction of unnecessary use of PPIs," the study concludes.Editorial: Adverse Effects Associated with Proton Pump InhibitorsAdam Jacob Schoenfeld, M.D., and Deborah Grady, M.D., M.P.H., of the University of California, San Francisco, wrote a related editorial summarizing recent data on the adverse effects of PPI use."A large number of patients are taking PPIs for no clear reason -- often remote symptoms of dyspepsia or "heartburn" that have since resolved. In these patients, PPIs should be stopped to determine if symptomatic treatment is needed," they conclude.

Story Source:The above post is reprinted from materials provided by The JAMA Network Journals. Note: Materials may be edited for content and length.